Humana CEO Cheers for Risk-based Models

OncLive Chairman,

Mike Hennessy

Value-based reforms from CMS have been received like extra work at the end of a long hard day. It hasn’t helped that making the leap to patient-centered care has involved grappling with a new set of quality metrics and wringing higher levels of performance out of electronic health reporting systems. Among oncologists, it’s generally accepted that this transition away from volume-based medicine is ultimately going to be a good thing. But to call the level of excitement “feverish” would be an exaggeration.

However, there’s one group out there that could be described as almost gleeful about the future of medicine in a risk-based environment. Roy Beveridge, MD, senior vice president and chief medical officer of Humana, recently told a group of oncologists at the Patient Centered Oncology Care (PCOC) conference in Baltimore that payer metrics conclusively indicate that patient care improves as physicians become more vested in patient outcomes. According to Beveridge, better outcomes mean more focused medicine and less waste, which, in the payer view, means savings.

In this month’s Oncology Business Management^TM, read about why Beveridge believes that CMS’s quality metrics-based reforms are going to dramatically improve medical results. The report from last month’s PCOC meeting is on page 15.

This month, we’ve also included a report on a super-utilizer solution that originated in Camden, New Jersey, and was successfully replicated by an oncology center in Greensboro, North Carolina. Cone Health worked to understand its most costly set of oncology patients and find out how their expenses could be reduced without adverse effect. The health center found a number of ways to improve the coordination of care and keep those super utilizers from overusing emergency departments and hospital beds. Our story, on page 10, explains what was done. Cone Health’s experience is a useful lesson for institutional and independent oncology care centers alike.

CVS has had to back down from its planned policy of refusing to supply Medicare Part D oncolytics to in-house dispensaries, to the enormous relief of independent oncology practices across the country. It is not clear what type of discussions occurred between CMS and CVS that led to the decision not to go ahead with the sequestration, which would have begun in January, but many insist that in-house dispensaries have an important role to play in oral oncolytic distribution. Still, patient advocate Hagop Kantarjian, MD, University of Texas MD Anderson Cancer Center, contends that patients should obtain their drugs from the lowest-cost suppliers, which are retail pharmacies in many cases. Some would counter that “lowest cost” means better managed care and less drug waste, which is why in-house dispensaries contend they are superior to retail pharmacies. Our story about this still-simmering issue is on page 8. Be sure to read it.

Also, check out our many other offerings this month. Our issue includes an update on CMS’s Quality Payment Program and its physician performance standards. There’s also a close-up look at some of the policies that payers have adopted to control the cost of immuno-oncology drugs. Enjoy!